Scaling Mhealth in Africa: Lessons From The Implementation of The MomConnect Program

Abstract Background: Mobile health programs have strengthened health systems in Low- and Middle-Income Countries (LMICs) to achieve health-related goals. MomConnect, a mobile health program in South Africa targeted at improving antenatal and maternal health, has scaled rapidly since its creation in 2014. This study explores the barriers and facilitators to the implementation and scaling of the MomConnect program and the applicable lessons for the scaling of mhealth programs in the region. Methods: We conducted a qualitative study with key project partners and leaders who worked on the MomConnect project. Interviewees were initially identified through a literature review, publications, and evaluations of the project. Interviewees included individuals serving in implementation oversight, champions, partners, funders and frontline implementer roles. The Consolidated Framework for Implementation Research (CFIR) informed the a priori codes for directed content analysis. In total, 15 key stakeholders were interviewed. Interviewees were asked to identify any barriers or facilitators to the implementation of MomConnect and how they would overcome those barriers and strengthen the facilitators. Results: This qualitative study identified multiple barriers and facilitators to implementation within our domain of CFIR: characteristics of the intervention (complexity, trialability, evidence strength & quality, cost, design quality & packaging, adaptability), inner setting (available resources, compatibility, implementation climate, access to knowledge & information), outer setting (cosmopolitanism, external policy & incentives) and process (planning, external change agents, champions, formally appointed internal implementation leaders). Overarching thematic areas spanning the barriers and facilitators included: (1) strategic partnership and coordination across multiple sectors, (2) innovation costs and funding, (3) operationalization of the innovation to local and national settings and (4) mhealth policy and legislation frameworks.Conclusion: The barriers and facilitators identified under the CFIR domains can be used to build knowledge on how to strengthen mhealth programs in Africa. The continued success of the MomConnect program will require overcoming identified barriers and capitalizing on known facilitators. These findings can serve as a foundation for the effective design and scale of mhealth interventions in the region.